医疗保险多重疾病患者的种族和民族对再入院和出院后死亡率的影响。
Readmissions and postdischarge mortality by race and ethnicity among Medicare beneficiaries with multimorbidity.
机构信息
Division of General Internal Medicine and Health Services Research, Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
出版信息
J Am Geriatr Soc. 2023 Jun;71(6):1749-1758. doi: 10.1111/jgs.18251. Epub 2023 Jan 27.
BACKGROUND
Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics.
METHODS
We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity.
RESULTS
The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR = 1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity.
CONCLUSIONS
Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.
背景
在患有多种合并症、残疾和未满足的社会需求的复杂患者中，再入院风险及其存在的差异尚不清楚。在个体水平数据有限的基于索赔的研究中，这些特征可能被低估。我们试图通过严格调整多种合并症、身体功能以及社会人口统计学和生活方式特征，来检查不同种族和民族的再入院和出院后死亡率的风险。
方法
我们使用健康与退休研究（HRS）数据与医疗保险索赔相链接。为了获得 ICD-9-CM 诊断代码以计算 ICD 编码的多种合并症加权指数（MWI-ICD），我们使用了 1991 年至 2015 年期间的医疗保险 A 部分和 B 部分（住院、门诊、承保人）文件。参与者必须在 2000 年 1 月 1 日至 2015 年 9 月 30 日之间至少有一次住院治疗，并且在住院前一年持续参加医疗保险 A 部分的自费服务。我们使用多变量逻辑回归来评估 MWI-ICD 与 30 天内再入院和出院后 1 年死亡率之间的关联。使用 HRS 数据，我们根据年龄、性别、BMI、吸烟、身体活动、教育、家庭净资产和居住安排/婚姻状况进行了调整，并检查了种族和民族的影响修饰作用。
结果
最终的 10737 名参与者的平均年龄为 75.9±8.7 岁。西班牙裔成年人的 MWI-ICD 平均值最高（16.4±10.1），其次是白种人（14.8±8.9）和黑种人（14.7±8.9）。MWI-ICD 与较高的再入院几率相关，并且种族和民族没有明显的修饰作用。对于出院后死亡率，MWI-ICD 每增加 1 分，死亡率的几率就会增加 3%（OR=1.03，95%CI：1.03-1.04），这与种族和民族没有显著差异。
结论
在所有种族和民族群体中，多种合并症与 30 天再入院和出院后 1 年死亡率的单调增加几率相关。在经过严格调整后，种族和民族对再入院或死亡率的风险没有显著差异。
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